Integrated Care Boards (ICBs) and primary care providers share an opportunity to enhance patient care through proactive services in line with national and local priorities. Local enhanced services (LES), quality outcomes framework (QOF) schemes and the NHS prevention programmes (NPP) provide important opportunities to tackle some of the most pressing health needs but bring with them additional administrative burdens. Practices need to be able to identify which patients to target and accurately report on activity completed, while ICBs need to manage performance and monitor impact.
Digital tools exist to make the process easier, but while there are mandated processes for national programmes, local schemes are much more varied, with some practices reliant on manual processes that work, but are resource intensive. And therein lies the dilemma – do you stick with what you know or take time out to learn a new system or feature, knowing it will be worth it long term?
In our experience, those that have had the opportunity to make better use of digital tools have benefited significantly, and the growth of at-scale working makes the argument for consistent processes more compelling. But enabling more practices and PCNs to benefit means improving awareness of what’s possible and making it easier to implement new ways of working.
Making clinical systems work harder
Clinical systems are constantly evolving in response to new demands. Understandably, practices often rely on the familiar functionality that has been in place from day one but are less familiar with the newer capabilities that can save time and improve accuracy. Taking a moment to step back and assess what clinical systems can really do to support practices in today’s environment is challenging but can be transformative, both for patient care and for practice performance. But how can this be achieved?
1. Capitalise on existing digital expertise in your area. Whether it’s tech-savvy GPs developing their own solutions to day-to-day issues, or clinical system super-users working across your PCN, sharing learning and developing PCN-wide or system-wide solutions accelerates impact. For example, a GP in Hampshire has developed a protocol which manages the data entry automatically when seeing multiple patients in clinic. The quality of information recorded doesn’t change but the time taken to complete it is reduced, freeing up more time for patient care. Sharing and building on these pockets of innovation encourages a problem-solving approach among clinicians and clinical systems specialists based on a better understanding of the art of the possible.
2. Configure your systems to support local needs. Although there are plenty of useful tools and templates supporting core activities, these can often be adapted to more accurately support specific local priorities and preferred ways of working. We are working with PCNs to optimise third party templates to suit local priorities and set up unified processes for data collection and reporting, for example. This means staff working across multiple practices have a consistent process for recording activity and PCNs can reliably compare like for like performance across their practices.
3. Invest in training. On-the-job training in digital systems is commonplace but risks perpetuating limitations in use based on existing understanding. Accessing external training led by systems experts or software providers themselves provides an opportunity to discover new and different features that can support clinicians, as well as hints and tips to streamline data entry and help with day-to-day processes.
4. Be vigilant about coding. The benefits from digital systems can only be realised if information is accurately coded. However good your systems, templates and searches may be, if the coding is incorrect, information will be missed which can mean patients miss out on targeted interventions and practices don’t get paid for all the work they do.
System-wide access to digital tools
It’s not just clinical systems that hold the key to improved efficiency and enhanced patient care. Increasingly ICBs are commissioning system-wide digital solutions which offer a more consistent approach to reporting. In some cases, these systems are freely available to the NHS but not yet fully utilised.
A good example is the calculating quality reporting service (CQRS) local system, developed by the Commissioning Support Unit (CSU) Collaborative on behalf of NHS England to improve reporting efficiency and accuracy for LES. This is a cloud-based service developed with end users to create a user-friendly, intuitive system which requires just 30 minutes of training to use. CQRS Local can be configured to local priorities, from initiatives such as the Ukrainian health check scheme or safeguarding activity through to very specific localised initiatives, such as polio vaccinations in at-risk areas. LES for each PCN are pre-coded, making the process of uploading activity quick and accurate, while enabling more consistent reporting across a system. Twenty ICBs and hundreds of GP practices currently use CQRS Local which has eliminated reliance on spreadsheets and emails for submitting LES claims.
Unlike the Network contract directed enhanced service (DES), where reporting is mandatory using the CQRS National system, a single approach to reporting isn’t mandated for LES which puts the onus on ICBs to identify and implement suitable processes. By working collaboratively, ICBs and primary care providers have an opportunity to identify the tools and systems which not only enhance care delivery, and improve reporting and analysis, but do so in a user-friendly way that provides tangible time savings for practices.
By Lisa Whattam, clinical systems training manager at NHS Arden & GEM CSU and Joshua Slater, communications and engagement manager at NHS Midlands and Lancashire CSU
